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HomeMy WebLinkAbout12-18-12 (2) PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as specified below, and in support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form: Decedent's Information / Name: HOWARD L. ANDERSON. JR___ File No: -/2/ l Y a/Wa: (Assigned by Register) aWa: aWa: Social Security No: 367-40-2605 Date of Death: 10/10/2010 Age at death: 69 Decedent was domiciled at death in CUMBERLAND County, PENNSYLVANIA _ (State) with his/her last principal residence at 24 EAST WINDING HILL ROD MECHANICSBURG CUMBERLAND Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 24 EAST WINDING HILL RD MECHANICSBURG CUMERLAND PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: If domiciled in Pennsylvania All personal property $ 5.000.00 If not domiciled in Pennsylvania .............................Personal property in Pennsylvania $ If not domiciled in Pennsylvania .............................Personal property in County $ Value of real estate in Pennsylvania $ 45, 000.00 TOTAL ESTIMATED VALUE.... $ 50,000.00 Real estate in Pennsylvania situated at: 24 E. WINDING HILL ROAD MECHANICSBURG CUMBERLAND (Attach additional sheets, ifnecessary.) Street address, Post Office and Zip Code City, Township or Borough County M A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated 5/6/2045 and Codicil(s) thereto dated State relevant circumstances (e.g. renunciation, death oferecutor, etc.) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and did not have a child born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. M NO EXCEPTIONS ❑ EXCEPTIONS ❑ B. Petition for Grant of Letters of Administration (If applicable) c.t.a., d.b.n., d.b.n.c.t.a., pendente lite, durante absentia, durante minoritate If Administration, ca.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs. Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been establisk¢ as defined in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. n v ❑ NO EXCEPTIONS ❑ EXCEPTIONS C C) M 01 t= r •I Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the follpyongg pt, e (if SR) and, irj p;wach additional sheets, if necessary): y, r F -A t l "I I r- rn Co Name Relationship T. _ C> ~ --;ter;--- 't7 -A w._ - - CD Page 1 of 2 Form RW-02 rev. 10/11%20I1 • Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND } Petitioner(s) Printed Name Petitioner(s) Printed Address 24 EAST WINDING HILL ROAD SUSAN L. ANDERSON MECHANICSBURG PA 17055 The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the Decedent, the Petitioner(s) wi well at>d truly administer the estate accordin to law% Sworn to or affirmed and subscribed befoye 1 Dat \ , met day of Date Y~ Date For the Register Date BOND Required: ❑ YES M NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters Attorney Signature: ) Short Certificates(s) ( ) Renunciation(s) ( ) Codicil(s) - - ( ) Affidavit(s) Bond Printed Name: Commission Supreme Court Other . , , ID Number: Firm Name: Address: Phone: Automation Fee Email: - - - JCS Fee TOTAL DECREE OF THE REGISTER / Estate of HOWARD L. ANDERSON,_JR_ File No: oo & Wa: AND NOW, in co side ation of the f r~going Petition, satisfactory proof having been presented before me IS DECREED that Letters LZ!t,~l ' are hereby granted to in the above estate and (if applicable) that the instrument(s) dated A described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. E. w &u U Register of Wills 1!y Form Rw-oz rev. roitvzott Page 2 of 2 u.. ~..:,Cr~ Itl r col!,F LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this dopy by photostat or photograph. Fee for dlis certificate, SOO) ~t :11 i,, Io certify that the intorm,(Uon here <Lkcn is XYM` ~Ly c(I ccll~ copied Ilum an original Certificate of Death L; ik (;iei( %~ilh me is i 1 c cl Rc2i,,t (r, The original lcihl)("ltc %eill he (un~ udeil to the State Vital Pcct)I(k (A icc 101 pcrm:(nent filing. P 16809795 C'erulication vumhc'r - i-i)cal Rdmstral e'v Date Issued M(o M c7 n - rp A t- t--A 01 ft' t M CO ;0 C-1 U) 2 C°a ""T7 c~7 N P'~" r"t1 TV A C> V7 H105-143 REV 11/2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS TYPE / PRINT IN PERMANENT CERTIFICATE OF DEATH BLACK INK (See instructions and examples on reverse) STATE FILE NUMBER 1. Name o (Decedent (Rion, middle, last, suffix) 2. Sex 3. Social Seanry Number 4. Data of Death (Month, day, year) Howard Leonard Anderson, Jr Male 367 - 40 -2605 October 10, 2010 5. Aga Law Birthday) Under 1 year Under 1 day 6. Date of Birth (Month, day, year) 7. Blnhplace (Cry, and slate or foreign country) as. Place of Death (Check only one) Maas Days zwvrs ks'rwm Hospital: 1 Other 69 vrs July 22, 1941 Flint, MI [I Inpatient ❑ ER I lMpationt ❑ DOA ❑ Nursing Home esitle_ ❑Oller - Spedy: eb. County of Death ac. City, Both, TWp of Death 8d. Facility Name (If not insEhpon, give street and number) 9. Was Decadent of Hispanic Origin? 6 No ❑ Yes 110. Race: American Indian, Black, While etc. Cumberland Lower Allen 24 East Winding Hill Road (If yes, specify Cuban, White Mexican, Puerto Rican, etc.) 11. Decedent's Usual lion Kind of Work done most of Me. Do not slate rented 12. Was Decedent ever in the 13. Decetlein's Education (Specify only highest grade completed) 4. Marital Status: Marred, Never Marred, 115. Surviving Spouse (If wile, oe maiden name) sixiding Kind d Work Kind of B- / Industry U.S. Armed Forces? FJemenary/Secondary (012) CDlage (13 or 5+) I Wed. Divorced (Sped)){ Maintenance Engineer Construction Xnes ❑NO 12 Married Susan Adams Moharter 16. Decedent's Mailing Address (Sheet, city / town, state, zip code) Decedent's PA Did Decedent Older Afflen 24 East Winding Hill Road Actual Residence, 17a. State Live ina 17c.~ Yes' Decedent Lived in T"p Mechanicsburg, PA 17055 17b. County Cumberland 17d.❑NDeLimits of nt Lived Mhn Co Bom 16. FamerS Name(RreL middle, last, sulfa) Howard Leonard Anderson 19. Mothers Name lRrsc nildle. mataer' aemame) Wilma Huddleston 20a. InformanYS Name (Type / PAM) 20b. Informant's Mailing Address (Street, city / town, state, code) Susan-Anderson - - - 24 East Winding iPill Road Mechanicsburg, PA 17055 21 a. Method of DLRpasidm 03 jemabon ❑ Donation 21b. Dale of Dksposition (Morph, day, year) 21c. Platy of disposition (Name of cemetery, crematory or other place) 21d. Location (City /own, Stale, zip castle) o ❑ Burial ❑ Removal homState Was Cremation orDonation Au&wmd October 12, 2010 Conolite Crematory Schaefferstown, Pa. 17088 ❑ Omer - Spedry: by Medical Examiner / Coroner? ❑ Yes ❑ No 117 228. Sigh Ore as such) 22D. License Number 221. Name and Adtlress d FecMy ► FD-012662-L Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, PA 17055 Items c aay when carliffiring 23a. T . Df my . death caned d tls a-, data and place slated. (Signature ,it title) M. License Number 23c. Date Signed (Month, day, year) physician is not variable at time of death to t C - 1 ceniy cerise of death. c l~ Y 1 C~ J N SJ ' ~1 U ken 24-26 must be complded by person 24. Time of Death . Dale Pmnamcsd Dead (Mash, day, year) 26. Was Case Referred to Medical Examiner / Coroner for a Row- Other man Cremadm or Donator? who p,- death. 115 t1 M, 1 h r-) ) ❑ Yes No CAUSE OF DEATH (See instructions and examples) , Approximate interval Pan II: Enter ower sionifit cardsias conabulirw to death. 28. Do Tcizacce trEule to Death? Item 27. Pan 1: Emer the chain of events - diseases, injuries, or mmplicatias - that directly caused the death. DO NOT enter terminal events such as camac acres,. Onset to Death but trot resulting in me underlying cause given in Pan I. ❑ Ves roomy respiratory, arrest, on ventricular fibrillation without stowing the etiology. List ody one cause on each fine. n ❑ ❑ Unbawn mom TEr E CAUSE fFinal) isease or n t, death a. tl T), 29. K Female: Due to (or as a consequence of): ❑ Not pregrem Wain past year sQue tithe cause laleda fir's a. i ❑ Preg,um at eme of death Ny ' am b' Ether Bs UNDERLYING CAUSE Due to (or as a consequenra of): ❑ Not pmgnam, but pregnant w+min 42 days i (disease m injury mat kdiialad the o of death evens ras,xNg m death) UST. Due to (or as a consequence of): ❑ Not pregrimL be, pegnam 43 days to 1 year before death tl. ❑ Unknown tl pregnant within the past year 30a Was W Autopsy 30b. Were Autopsy Findings 31. Manner o (Death 32a. Date of Injury (Month, day, year) 32b. Descnbe How Injury Orxumed 32c. Pace of Injury: Home, Farm, Sped, Factory, Parlor d? Available Prior to Compatien Office Building, etc. (Spedlyi of Cauca d Death? ~25L Nasual ❑ Hamicoe ❑ Yes No ❑ Yes ❑ No ❑ Accident ❑ Pending Investigation 32d. Time of In 32e. Injury at Work? 321. If Transpwtatlon Injury (Specilyl 32g. Locaton of Injury (Shed, city /town, sate) ❑ Suicide ❑ Could Not be Determined M ❑ yes ❑ No ❑ Driver / Operator ❑ Passenger ❑Pedestmn ❑other- si-ty. 33a. CeNGer (dark only onel 33b. Signature ant r r C flying physician (Physician certifying cause of death when another physician has pronounced death and completed Item 23) To the baste my krwwletlge,deam occurred due to the cause(s) and manner as alate4 ► ~Q"^' '1/~i.,. C^ • Pronouncing and certifying physician (Physician both pronouncing death and ratifying o caused death) 33c. License Number 33d. Data SOW (Mash, day, year) To the bed of my lmowledge, death occurred at the [me, date, and place, and due to the cause(s) and manner as stated------------------ ❑ • Medical Examiner I Comner ~'l(~ C.iS S 1 1 Z On the bests of examination and tor Investigation, In my opinion, death occurred at the time, data, and place, and due to the cause(s) ant manrsr u sated- ❑ 34 Name and Address of Person Who Completed Cause of Death (hem T7) Type / Print • LLD 35. Reg rs Signature and District Number: 36. Date Filed (Month, day, year 7ty ► c, ` 12211 IT~21 % ICI ono r'r Ar:n ~Pr: AY C~ 7~ Trl rn cam rn~~ r rn Co LAST WILL AND TESTAMENT x r .i C 5 Cpl 'q l HOWARD L. ANDERSON, JR. 1 b r : - `n N i r n KNOW ALL MEN BY THESE PRESENTS, That I, HOWARD L.3ANDER N, JR., of the Township of Upper Allen, County of Cumberland, and Commonwealth of Pennsylvania, do make, publish, and declare this instrument to be my Last Will and Testament, hereby revoking and making void any and all former Wills by me at any time heretofore made. FIRST: I direct the Executrix hereof to pay all my just debts, funeral expenses and costs of administration as soon as conveniently may be done after my death. further direct the Executrix hereof to pay all inheritance, estate, transfer and succession taxes which may be levied or assessed upon any property which is included as part of my gross estate for the purpose of any such tax. SECOND: I give, devise and bequeath unto my Wife, SUSAN L. ANDERSON, the rest, remainder, and residue of my estate provided that she survives me by a period of thirty (30) days. THIRD: In the event that my Wife, SUSAN L. ANDERSON, does not survive me by a period of thirty (30) days, then in that event, I give, devise and bequeath the rest, residue and remainder of my estate to my Daughter, GERRY LYNN ADAMS, per stirpes. FOURTH: I appoint my Wife, SUSAN L. ANDERSON, to be Executrix of this my Last Will and Testament. I do hereby give to the Executrix hereof full power, discretion and authority at any time or times to sell, at private or public sale, mortgage, lease, pledge, -1- exchange or otherwise deal with or dispose of the property comprising my estate as deemed best, to settle and compound any and all claims in favor of or against my estate as deemed best and, for any of the foregoing purposes, to make, execute and deliver any and all deeds, mortgages, contracts, leases, bills of sale or other instruments necessary or desirable therefor. FIFTH: In the event my Wife, SUSAN L. ANDERSON, fails or refuses for any reason to serve as Executrix of this my Last Will and Testament, then in that event I appoint my Daughter, GERRY LYNN ADAMS as Executrix of this my Last Will and Testament. LASTLY: I direct that no fiduciary appointed by this, my Last Will and Testament, shall be required to give bond and that if, notwithstanding this direction, any bond is required by any law, statute or rule of court, no surety shall be required thereon. IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, consisting of three (3) typewritten pages on the margin of which (except this page) I have affixed my initials this 6'h day of May, A. . 2005. HOWARD L. ANDE ON, JR. Signed, sealed, published and declared by HOWARD L. ANDERSON, JR., the above-named Testator, as and for his Last Will and Testament, in the presence of us and each of us, who at his request, and in his presence, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. -2- County of Cumberland ss. Commonwealth of Pennsylvania ACKNOWLEDGMENT AND AFFIDAVIT We, HOWARD L. ANDERSON, JR., the testator, and the undersigned witnesses to the Will, the attached or foregoing instrument, having been qualified according to law do depose and say: (a)that I, the testator, do hereby acknowledge that I signed the instrument as my Will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and (b)that we, the witnesses, were present and saw the testator sign the instrument as his last Will, that he signed it willingly and as his free and voluntary act for purposes therein expressed; that each of us in the hearing and sight of the testator signed the Will as a witness and that to the best of our knowledge the testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed before me by HOWARD L. ANDERSON, JR., testator, and Amy Knauer and Beth Myers, witnesses, this 6th day of ay, 2005. OWARD L. DER N, JR. n ~ c ~L David W. Kna a (Witness) ATTORNEY I.D. No.21582 fitness / -3- ACKNOWLEDGMENT On this, the 6th day of May, 2005, before me the undersigned officer, personally appeared HOWARD L. ANDERSON, JR., known to me, (or satisfactorily proven) to be the person whose name subscribed to the within instrument and acknowledged that he executed the same for the purpose herein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. NOTARY PUB I My commission expires: NOTARK SELL MAY KNAUER Notary PubSc mrwmcwwQoPcLGKamm*DoMW My convnbdon Expkw ion 25.2009 -4- REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA No. 21-i ,~"1t~( 0 c Estate of `_sL Q c d A_V6LC,"~_YJ--\\1_,Deceased UNAVAILABLE WITNESS AFFIDAVIT being duly sworn according to law, depose and say that I, the ❑ Attorney tkPersonal Representative in the above referenced Estate, declare that L/ ~ na ~ < r and q M V/ t"l na (it ,r- whose signature(s) appears as subscribing witness(es) to the )4Will or ❑ Codicil of the above Testator is/are not readily available to prove the signature to the Testator by reason of C-) y nd r.a Sworn to or affina?d subscribed x Before me this I t day of Signature of Counsel/Per nPRepres~tatia',~ > za C cn : r Rr) l~~ f~ , 20 co rn -y- c) c ;0 > - M ITI r- z M Co Cj O-C a De ut for R~ ister o ill C-.) C) ni p y ~g C-') C) (Must sign in Regis er's ffice) C7 r,1 1 OATH OF NON-SUBSCRIBING WITNESS and (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that he is/she is/they are familiar with the signature of the above Testator of the ❑ Will or ❑ Codicil presented herewith and that he/she/they believe(s) the signature on the ❑ Will or ❑ Codicil is in the handwriting of the above Testator to the best of his/her/their knowledge and belief. Sworn to or affirmed and subscribed ` Before me this day of Signature of on-Subscribing Witness 20~_ R p ~ Signature of Iron-Subscribing Witness Deputy for Regist Wills (Must sign in egister's Of ce) C~L REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA No. 21- I - I .7 1 , Estate of t Deceased UNAVAILABLE WITNESS AFFIDAVIT being duly sworn according to law, depose and say that I, the ❑ Attorney] Personal Representative in the above referenced Estate, declare that 11 it l E' 1~ and 1 1 whose signature(s) appears as subscribing witness(es) to the Will or ❑ Codicil of the above Testator is/are not readily available to prove the signature to the Testator by reason of tr: } G' Sworn to or affirmed and subscribed ore me this day of Signature of Counsel/Pers@al Represea ive, ;r 20~ a © rn rn ca C> `v C] rn _r C1.) Cn~,a b t'i`t r~o nj "I Deputy for Regis o c a .t ...ri (Must sign in egister's Tice) .n OATH OF NON-SUBSCRIBING WITNESS N -,.I and (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that he is/she is/they are familiar with the signature of the above Testator of the ...Will or ❑ Codicil presented herewith and that he/she/they believe(s) the signature on the Will or ❑ Codicil is in the handwriting of the above Testator to the best of his/her/their knowledge and belief. Sworn to or affirmed an4 subscribed ore me this l day of Signature of Non-Subscribing Witness 20 41A Signature of Non-Subscribing Witness F4put"y for Register ersOffice (Must sign in Regif